Functional gut disorders such as IBS are affecting one in five Americans, causing abdominal pain, inconsistent or excessive bowel movements, and even psychological symptoms such as anxiety or depression. (1) If you have experienced IBS, you know that these symptoms can be constant, painful, and can have a serious impact on quality of life.
If there were a dietary intervention that could reduce or eliminate IBS symptoms, would you try it?
There is a strategy that has recently become more popular; it is a dietary approach that I have seen work well for many of my patients, and that evidence is growing in support of. Known as the Low FODMAP Diet, this method has been demonstrated to reduce functional gut disorder symptoms in approximately 75% of patients. (2) Understanding how FODMAPs affect the gut and knowing how to eliminate them from your diet may be the key to getting your IBS symptoms under control.
What are FODMAPs?
These short-chain carbohydrates are incompletely absorbed in the gastrointestinal tract and can be easily fermented by gut bacteria. (3) These sugars also exert an osmotic effect, increasing fluid movement into the large bowel. (4) The fermentation and osmosis caused by these undigested sugars are a cause of major IBS symptoms such as gas, pain, and diarrhea.
There are many common foods that are high in FODMAPs that can potentially contribute to IBS symptoms, even if they are considered healthy by most standards. Lactose from dairy products, fructose from certain fruit, coconut products, and sweeteners, fructans from fibrous vegetables, and polyols from fruit and sugar alcohols are all rich in FODMAPs and can be difficult to digest for people with functional gut disorders. These foods can cause serious and painful symptoms in those with IBS and Crohn’s disease.
Who may have FODMAP intolerance?
While most IBS patients are FODMAP intolerant, consuming FODMAPs does not actually cause IBS; it simply exacerbates symptoms. (5) Therefore, while many people may be able to consume a large quantity of FODMAPs with no problem, some people will experience an abnormal or exaggerated response to the presence of these poorly absorbed saccharides. (6) And while all FODMAPs can potentially factor in the development of IBS symptoms, the relative contribution of different types of FODMAPs varies across ethnic and dietary groups depending on the amount of each in the diet. (7) Additionally, individuals differ in their amount of malabsorption of FODMAPs such as fructose, lactose, and fructans, and therefore are more or less sensitive to certain FODMAPs in particular.
So what causes FODMAP intolerance? There are a few possible explanations that have been explored in clinical study. In some cases, small intestinal bacterial overgrowth, also known as SIBO, contributes to the development of IBS symptoms and FODMAP intolerance. (8)
Of course, emotional and physical stress are also known to be contributing factors to the development of IBS, and could induce FODMAP intolerance for reasons not yet fully understood. (9) In these cases, disturbance of gut microbiota is a likely causative factor; as we know, stress alters the gut flora significantly and could be the reason why stress, FODMAP intolerance, and IBS are so closely linked.
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How can you treat FODMAP intolerance?
First, addressing intestinal bacterial overgrowth or imbalance is key; even if you don’t have IBS, gut dysbiosis can lead to poor digestive function as well as contributing to FODMAP intolerance. There are a few gut-healing protocols available today, such as the GAPS Diet or the Specific Carbohydrate Diet; my personal approach is similar to an autoimmune Paleo diet. I often recommend probiotics to my patients to help balance out their gut flora, and occasionally recommend antimicrobial treatments depending on the severity of the individual gut infection. Managing gut flora is a highly individual process, so it’s important to pay attention to your own symptoms when coming up with a treatment plan.
In addition to addressing gut bacteria, following a low FODMAP diet seems to be the most effective dietary intervention to help reduce chronic IBS symptoms. (10) Many clinical trials have shown a high level of success from IBS patients who reduce or eliminate FODMAP containing foods from their diet. (11, 12, 13) In addition, avoiding gluten may help reduce IBS symptoms further, according to some research. (14)
While a “Paleo” or “Primal” diet may eliminate many of these culprits, there are a few Paleo-friendly staples that can worsen FODMAP intolerance symptoms. I’ve written about coconut milk causing digestive distress in some individuals, and coconut milk is an unfortunately high source of FODMAPs. Many fruits such as apples, peaches, mangoes, and watermelon are FODMAP rich, and dried fruits are especially problematic for those with intolerances. Even certain vegetables that are normally quite healthy can be problematic for those suffering from IBS; asparagus, brussels sprouts, broccoli, garlic, and onions are just a few of the vegetables that could be exacerbating symptoms.
To determine which specific foods that may be causing your IBS symptoms, I recommend reviewing this basic but informative chart featuring different types of FODMAPs and the foods they are found in. You may be consuming a FODMAP-rich food without knowing it, and reducing or eliminating consumption of these foods may help alleviate IBS symptoms. This chart also provides a list of low FODMAP foods that can be enjoyed in place of these problematic foods.
For much more information about FODMAP intolerance, as well as an extensive list of FODMAP foods and an in-depth gut healing protocol, check out my Personal Paleo Code. In this detailed guide, I explain how to best adapt the standard Paleo diet into one that can help relieve IBS symptoms without needing to restrict your diet indefinitely. It’s a protocol I use with my patients, and many have found success without drugs or surgical intervention. It’s certainly worth a try for anyone suffering from chronic digestive disorders.
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When my brother was diagnosed with IBS, this drastically changed our life. She had been very ill mainly due to malabsorption and diarrhea that led to huge weight and energy loss. Doctors couldn´t find the cause or proper treatment.
The only thing that helped him to get better was with the help of the low FODMAP diet. It worked wonders on his sensitive gut and was literally a lifesaver!
Since then I am focused on developing products and helping others suffering from the same condition by sharing low FODMAP food items, recipes and low FODMAP cooking tips.
You can find us at: http://www.casadesante.com
Unfortunately, there are a lot of people who aren’t aware about such issues and end up complaining about abdominal pain, inconsistent or excessive bowel movements, without knowing the cause. I personally know a person who eventually found out that she was suffering from IBS after she had to deal with a severe depression for a few months…
Really helpful article but I think people should definitely consult a dietitian for this to ensure they are getting good advice on what to eat, how to eat it, and when to eat it. They can help plan a daily routine and help write up shopping lists and handy recipes that take an individual’s needs into account. Also, with reintroduction, the guidance is strict on how to challenge your system and ensure you eliminate the right foods. Your food chart differed from the one provided to me by a qualified dietician. Partly because my stomach was very upset by the time I started FODMAP and my symptoms were actually worse as I began the diet and didn’t kick in for several weeks. There’s no way I could have done this diet without a dietician.
Thanks for all the research. I’ve been trying to understand Fodmaps more because I’ve dealt with food allergies and trying to re-establish gut health. I wasn’t aware of the issue of coconut milk affecting digestion.
I’ve been on the low fodmap diet, I am also vegan. I’d tried it a couple of years prior to going vegan and I didn’t have the willpower to be strict with it.
I finally did it, It helped 90% of my symptoms but I lost a lot of weight. As soon as I started reintroducing I had issues flare up again.
My issue with it is.. I finished work early every day to plan out my meals, I even had to cook at a friends place so I know I was eating the correct foods, i spent a whole lot of money on food, and I wasn’t able to eat out for months, it is not easy to live life this way.
Not only that, but i was being overlooked by a dietitian and I wasn’t given any information to ‘heal’ my gut during this time, only to avoid.
There is so many conflicting information when you look at the gut healing protocol, don’t eat nuts, potatoes, tomatoes, peppers.
Yet they are ones of the few snacks/vegetables on the low fodmap diet that can be eaten!
I am only 24 and have symptoms of an autoimmune disease, but no diagnosis and every single test has come back as normal.
Confused and at a loss.
Hi Arliah,
I’ve also got autoimmune symptoms (swollen ankles and pain in feet and legs) in addition to stomach pains. I’ve had a lot of bloodwork, and nothing is positive so far. I eat vegan too, and have been keeping low FODMAPs for a week with some success. I’ve lost a lot of weight for my already thin frame, and I’m worried I’ll just keep losing more. Just wanted to say hi and give my email (jen jo smith at hotmail dot com – with no spaces) in case you wanted to be in touch.
Jenna
HI Jenna 😊 I have the same symptoms as u – I am vegan 2 … I havery been recently following a swami diet which is a combination of the bloodtype diet & genotype diet 2 gether – not 100% sure this is best 4 me – r u familiar with these @ all!!?? 😊
Hey buddy, please get yourself checked for hernia, I have the same issue but got to know that it was hernia
You need a dietician. You are not expected to follow this plan without guidance from a qualified nutritionist. See your GP for advice. I had to get a scope to ensure there were no underlying diseases or problems and she also recommended a dietician. You need to eliminate the stress of confusion from this!
I was monitored by a dietitian when I was doing it, and I stated that In my comment. I also had a gastroscopy and sigmoidoscopy, all fine.
I also stated that the dietitian told me nothing about healing my gut.
Since this comment I’ve had an IGG food antibody test and eliminated all food ‘allergies’ if you like. And it was explained to me that because of my leaky gut my body wasn’t creating its own digestive enzymes.. I’ve since taken supplements to get my body creating its own digestive enzymes, taken steps to heal a sluggish liver and used L-Glutamine for gut healing benefits, and I swear by it! Don’t have any issues with fodmaps anymore and are actually doing solid and regular bowel movements, inflammation, mouth ulcers etc. are all gone!
But this is something the doctors don’t know about!! I had to see a naturopath to get that information. No one told me it had anything to do with the fact my body wasn’t creating its own digestive enzymes, and that its more due to leaky gut in my case.
Problem solved! Get onto gut healing people!
What is L-glutamine?? Is it a prescription or over the counter?? What other supplements to help body to create its own digestive enzymes?? Have same problem, am taking probiotics but still have leaky gut.
Hello guys my nam is Ferdeous and i have ibs so i was wondering is mushroom good fr me or not
Mushrooms are very bad. Don’t have them at all.
I can’t for the life of me find evidence in your citation 2 that the low-FODMAP Diet “has been demonstrated to reduce functional gut disorder symptoms in approximately 75% of patients”. It’s claimed, but not demonstrated.
I’m not against the diet – it’s been very useful for me, & I wouldn’t be surprised if the claim were true.
Got curious about your comment and was glad I did as I found the paper helpful in understanding FODMAPs–it’s on pg 255 of the paper:
“Using a well-defined diet, restriction of fructose and fructans, together with general avoidance of other FODMAPs led to impressive global symptoms response in three out of four patients with IBS and fructose malabsorption in a retrospective study.”
Any advise as to whether D Mannose is fodmap friendly? My doctor is asking me to do a trial on the diet only before prescribing antibiotics, and it has helped enormously, but I would really like to use d mannose preventatively for utis if possible.
Does my past diagnosis of diverticulitis have any connection to my digestive issues? Over the last 12 years I discover slowly “another vegetable that upsets my system”. The diver diagnosis, and antibiotic treatment, occurred in 2010, twice. Mostly my issue is certain veggies. Almost 50, 5′ 3″, 123 pounds, high protein diet, lift weights. So, oerall healthy, except digestion issues.
A gastroenteritis and the consequent late diagnosis of IBS inhibited me from having a normal life for more that a year. I have been very ill mainly due to malabsorption and diarrhea that led to huge weight and energy loss. Doctors couldn´t find the cause or proper treatment. I finally started to get better with the help of the low FODMAP diet. It worked wonders on my sensitive gut and was literally a lifesaver for me! Since then I am focused on helping others suffering from the same condition by sharing my story and low FODMAP cooking tips. You can find me here: http://www.mygutfeeling.eu.
Thanks for your post. This is encouraging me to start my low FODMAP diet plan.
I have had a lifetime of allergies, IBS like stomach problems, asthma, skin problems, childhood eczema, back ache, diarrhoea, bladder sensitivity ( treated as infections), indigestion, chronic reflux, gut pain, headaches/migraines, itching, sinus infections and hay- fever. I never linked all these problems, nor did the doctors. Now I am so much better. But I have had operations, taken so many meds, antibiotics etc. that may not have been necessary if I had realized I was intolerant to FODMAPS earlier. I now carefully follow the Monash University Low FODMAP diet. It has been a lifesaver for me. If I accidently cheat I suffer, so I avoid eating out. How did I find out a “cure”. I had a fundoplication operation two years ago and following that I was crippled with IBS or whatever. Agony, embarrassment, huge weight loss of 15 kilos, I saw the surgeon’s dietician within a couple of months as I was so unwell, virtually bedridden, well toilet ridden anyhow. Food choked me. I couldn’t vomit just gagged. I was so sick I did exactly what I was told by the dietician. I kept a food diary. I blamed sugar , I did an elimination diet. Not white sugar. The we did Fodmaps elimination. Improved out of sight. Did challenges. Trouble with all but wheat seemed the least agony causing. But it is not worth cheating. I cant manage the spelt bread and wonder if I am also gluten intolerant. It is not easy to be so careful with food. I miss bread so badly, the gluten free stuff is a poor imitation. Get the real book on the FODMAP diet for $10 from Monash University, Australia.
I have suffered with IBS for many yeas. I have been treated with drugs (Lotronex, elevin, etc,). I am now on the FODMAP diet. It was so hard finding the foods minus all that made them taste good! The UDI’s brand bread, muffins, etc., are very good! It’s usually in the frozen section in your supermarket or a health store, i.e., Sprouts. You can find it on line – I just ordered rolls, bread, from the company in Colorado.
hi therza i have ibs and fodmap van u give me wat medicition u have use
Seems you are dealing with candida, look for that.
Lyn, Monash says sourdough bread can usually be tolerated. It is for me. I am lactose intolerant and was avoiding gluten also, but still had issues. Fodmap works. Hardest part – onion and garlic are everywhere, but I use tomato paste, diluted, with spices, and gluten free pasta. I don’t even need my lactase pills anymore because most cheeses are o.k. Gluten-free bagels make great mini-pizzas.
Rosemary